Oral manifestation of syphilis

Not only the lesions in the body helps us to know about syphilis but also a minute nodule or lesion helps us to discover the syphilis. He who knows syphilis knows the medicine well. Earlier you found the disease the treatment and the prognosis will be good. Discover syphilis through your body's gateway.

1. Oral manifestations of syphilis

2. Introduction Syphilis is a infectious disease of utmost importance nowadays,which has made a comeback after the appearance of AIDS. It may present oral lesion in all stages . It is also known as ‘lues’. The tertiary manifestations lead to considearble morbidity and mortality.

3. Etiology The causative organism of syphilis is Treponema pallidum. Sexual contact:It occurs most exclusively by venereal contact. Maternal transmission:Infection may transfer from mother to fetus. Drug user:Incidence of syphilis has increased nowadays in crack cocaine abuse . Predisposing factors:overcrowded living and primitive housing conditions.

4. Pathogenesis of syphilis Attachment and invasion via skin and mucous membrane during sexual contact and also trqnsplacentally Dissimination through lymphatic and haematological spread Acquired immunity-clinical manifestations caused by inflammatory and immune response rather than by any direct cytotoxic effect of treponeme Phagocytosis by macrophages and Tumor necrosis factor(predominant cytokine and mediator) Invasion of host immune response and estblishment of latent infection.

5. Classification

6. Primary syphilis Chancre is the main primary oral lesion Lips,oral mucosa,lateral surface of tongue,soft palate,gingiva and tonsils. Elevated ,ulcerated nodule showing Local induration. Covered by grayish white membrane. Regional lympadenopathy occurs.

7. Such a lesion on lip may have a brownish crusted appearance. Edema,redness,ulcerated,and eroded lesion-tonsils.

8. Secondary syphilis Oral lesions _ ‘mucous patches’ Slightly raised grayish white lesion surrounded by erythemamatous base. They are often ovoid or irregular in shape and are surrounded by erythematous zone.

9. These maculopapular lesions coalesce to form snail track ulcers On the distal and lateral tongue,lesions tend to be more ulcerated and irregular fissures may appear.

10. SPLIT PAPULE:It is a raised Papular lesion developed at the commisure of lip and with a fissure separating upper and the lower lip,giving a ‘split pea appearance’. CONDYLOMATUM:They are flat silver gray like PAPULE sometimes having ulcerated Surface.

11. Tertiary syphilis Classic lesion of tertiary syphilis is gumma. Gumma most frequently occurs in the skin,mucous membrane,liver,testes and bone. The intraoral gumma most commonly involves the tongue and palate that may perforate thorough the palatal bone into the nasal septum.

12. Atrophic or interstitial glossitis Occurs. In syphilitic glossitis ,the surface of tongue gets fissured due to atrophy and fibrosis of tongue musculature and hyperkeratosis.

13. Congenital syphilis It is transmitted in the uterus from the infected mother to the 16 week of pregnancy. EARLY SYPHILIS: Manifests during the first 3months of life as snuffles(nasal discharge purulent). L LATE SYPHILIS: Manifests at puberty.

14. HutchinsOn’s triad Hypoplasia of the incisor and molar teeth. Eighth nerve deafness. Interstitial keratitis

15. Other features Frontal bossae Short maxilla High palatal arch Saddle nose

16. Mulberry molars or moon’s molars

17. Peg shaped or screw driver shaped lateral incisors. Central incisors are notched at their biting surface. Widely spaced incisors

18. Relative protuberance of mandible Rhagades Prominent accessory mesiolingual cusp Of upper molar. Retarded root resorption of deciduous dentition.There may be ‘marring ‘ of permanent incisors. Malocclusion and open bite are present.

19. Diagnosis The most commonly used screening test are rapid plasma reagin(RPR),the venereal disease research laboratory test(VDRL). The most specific serological test are fluorescent treponemal antibody absorption test and microhaemagglutination test. Dark field examination and lesion biopsy Can be done.

20. Treatment Primary and secondary syphilis-two term doses of benzathine penicillin G 2.4 million units i.m ,applied one week part and for tertiary syphilis 3 to 4 doses. Patient allergic to penicillin may be treated with either ceftriaxone or tetracycline. Patient should be followed with repeated physical examination and repeated VDRL is to be done at 1,3,6,9,12,18 and 24 months,if VDRL is negative,patient is said to be cured. There is no dependable prophylactic measure other than sexual abstinence with infected partner.The use of prophylactic antibiotics locally is beneficial in pregnant women suspected to exposure.

21. REFERENCE : OMR : ANIL GHOM[ 3 rd Edition]. ORAL PATHOLOGY : SHAFERS [ 12 th Edition ]